News & Opinion

Yoga Improves Sleep Quality After Cancer Treatment

People 2 to 24 months post-cancer treatment may find relief from lingering sleep issues that developed during or after treatment by practicing yoga twice a week, a study published in the Journal of Clinical Oncology shows.

Background

Thirty to 90 percent of people treated for cancer report sleep problems including excessive napping during the day, trouble falling or staying asleep at night and waking up too early.

Yoga, a popular mind-body practice, couples exercise with mental focus and may relieve mental and physical stress; however, few studies have explored whether yoga improves sleep quality. The investigators on this trial wanted to find out if practicing yoga improved sleep problems reported by people previously treated for cancer.

Design

A total of 410 participants from 12 U.S. cities were recruited between 2007 and 2010. All of them completed standard treatment for cancer between 2 months and 2 years before joining the study, reported sleep disturbances on a standardized survey given to them by the study researchers, did not practice yoga regularly on their own for at least 3 months before starting the trial and were at least 21 years old. People with metastatic disease who received treatments other than long-term hormonal therapy or who were diagnosed with sleep apnea, a breathing disorder that interrupts sleep, were not eligible to participate.

Participants were randomly assigned to one of two groups: one that followed the Yoga for Cancer Survivors (YOCAS) program and one that followed standard follow-up care as directed by their oncologists.

In the YOCAS group

participants practiced a combination of Hatha yoga, the foundation of most yoga styles, and Restorative yoga, a gentle form focused on flexibility

twice-weekly, 75-minute group sessions that lasted 4 weeks were taught by registered instructors trained in the YOCAS program and held in yoga studios, community centers and community oncology practices

Four weeks from the start of the study, both groups completed surveys about their sleep quality at home. In addition, all participants wore actigraphs, monitors that create a record of sleep and rest cycles, on their wrists for 1 week, 24 hours a day, both before the study began and after it ended.

Results

Sleep quality scores were base don the Pittsburgh Sleep Quality Index, a standard survey filled out by participants. The actigraphs recorded how long it took each person to fall asleep and how often people woke during the night. Researchers estimated the overall quality of sleep from these measures.

The survey and actigraph data showed:

YOCAS participants slept better than standard follow-up participants, reporting less daytime exhaustion, better perceptions of how well they slept and less frequent use of sleep medicines

YOCAS participants slept longer and had fewer waking moments, better quality of sleep and less daytime exhaustion after 4 weeks than they had at baseline

standard follow-up participants improved sleep quality, had fewer waking moments, and better perceptions of how well they slept after 4 weeks on the trial than at baseline, but did not improve in daytime exhaustion, length of sleep, or sleep medicine use. Researchers believe the areas of improvement came from continued use of sleep medicine.

those participants who reported more than 60 minutes of waking during the night at the start of the study saw the most improvement after 4 weeks of yoga

Limitations

This study enrolled mostly Caucasian, well-educated, married women, so the findings may not be applicable to all groups of people. In addition, the study structure could only test one yoga program, so the results may not be the same if you practice another form. Trial investigators did not conduct a long-term follow-up study, so we do not know how long the sleep benefits last.

What This Means for You

Seventy-five percent of the participants in this trial were diagnosed with and treated for breast cancer. You may find comfort in knowing these findings add to earlier study findings that suggest yoga may help with managing anxiety, depression, insomnia or fatigue caused by a breast cancer diagnosis and treatment. This study used a large participant group and was held in more than one research location (known as a multicenter study); results from larger multicenter studies are the most widely applicable.

If you are interested in practicing yoga as an exercise intervention for sleep issues, talk with your doctor, a physical therapist or a social worker about finding a yoga class designed specifically for women with breast cancer.